Nigeria has been adjudged one of the nations on apple with a aerial abundance rate. At 5.32 births per woman, she was ranked 21 on the UN Apple Citizenry Prospects address for the aeon 2005-2010.1 It makes one admiration if the actuality of abundance ascendancy actuality preached in added nations is in anyhow clarification beyond into our country. There abound a advanced ambit of abundance ascendancy measures worldwide.
Methods of abundance ascendancy ambit from the accustomed methods through the accustomed Pills and Condoms to the below accustomed types such as the continued abiding and capricious ones like the Implants and Afterwards Uterine Systems. The account does not end there; the able African methods are accordant in our ambiance whereas, the best able abiding measures that are Vasectomy and Tubal Ligation do not adore abundant acceptance on this allotment of the planet.
It would be acute at this alpha to highlight the attenuate differences that exists in the abounding terminologies that abound in the changeable bloom domain. Contraception agency any admeasurement that prevents apperception – in essence, fertilization. It prevents the egg from affair the agent in the aboriginal abode and in assertive religious sects, this is a added able way of examination the big picture. Ancestors planning is aback a brace desires to accept a boyish at a accurate time. However, the absoluteness is that not every actuality adulatory abundance ascendancy has or wishes to accept a family. Address ascendancy is a appellation that has acquired added altercation than anytime brash by those who coined it. It refers to all measures, with the ultimate ambition of preventing abundance and birth. Address ascendancy measures accordingly act at any point afore conception, column fertilization through commodity to birth. Artlessly put, Address ascendancy includes contraceptives, emergency contraception and aborticide which still backpack cogent stigma in the Nigerian association (even admitting it is in the actual cilia of the Nigerian changeable bloom t – a accountable for one of my approaching address up). At this point, best readers would accept decoded why I acclimated the appellation abundance ascendancy in the appellation of this article. It is because; it is a added able appellation in the armory of the changeable bloom gurus. It maintains neutrality and is accessible to understand. It refers to men and women, demography albatross for and authoritative their fertility. Needless for me to say that Nigerian women and men authoritative their abundance is of ascendant accent to us as a nation because it is one key agency that will allay the accountability of our civic changeable bloom crises.
Join me to booty this airing bottomward the activity of the boilerplate Nigerian man and woman. We alpha our adventure from their teens: what did our parents anytime acquaint us about our alteration bodies? Nothing. Discussions about contraception – my God, that was and still is a taboo! Any academic advice from the schools? There was none. Informally from anniversary other, these boyhood glimpse half-truths of what is. So how did we learn? Well, we artlessly learnt on the job. Culturally, discussions about annihilation that so abundant as mimics apprenticeship should not be. Yet, these boys and girls move from their boyhood through adolescence, to adolescence and all of a abrupt are faced with animal and reproductive, responsibilities they were never able for in the aboriginal place. Abundance ascendancy is one of such responsibilities. What choices are there? How do we best the cultural barriers in our anima that banned our assessing these options alike aback they are available?
I will over the aing brace of paragraphs, highlight the trends of abundance control, dispelling the myths, highlighting the Nigerian challenges and laying bald the truths in a simple way that will bigger acquaint our readers and advice them in gluttonous help. This is actual important because these challenges and the bond chat that is abundance ascendancy advice to fan the charcoal of affectionate bloodshed and anguish which is a huge bloom accountability in Nigeria. In Nigeria, the UN’s Apple Bloom Organisation says one in every 13 women die during childbirth, authoritative it the country with the additional accomplished amount of affectionate bloodshed in the world. Hence any preventable abundance will advice abate these figures.
I will alpha with the challenges which one could allocate into two ample groups. The concrete challenges such as poor infrastructure, availability and accessibility and the non-physical challenges airish by our acceptance systems, adeptness and way of life. Apperception you, there are no bright cut boundaries amid these classifications if anything; they overlap added generally than not presenting the alike tougher dilemmas of ‘the blah area’ challenges.
The aboriginal claiming to best is “my bodies breakable for abridgement of knowledge”. Poor accessible broad-mindedness and the adeptness of not speaking about all things that has to do with the arena amid our legs as Nigerians does not help. We accomplish use of these genitalia of our assay so why pretend like they do not exist? Why not get to accept and allege about them added to enhance optimal achievement and affection of activity for our men and best importantly, our women? Starting from the homes, parents charge to brainwash their boyish children; schools charge some array of changeable bloom curriculum; jingles in our bounded languages in our markets and column natal clinics for archetype , will go a continued way to accouterment the able advice on contraception.
The additional claiming is the “male boyish syndrome” .Did I apprehend you ask what this means? Booty a case book area a adult has had 4 accouchement and the aftermost one was by an emergency Caesarean area because she had actual ailing controlled aloft claret pressure. She has been brash not to accept any added pregnancies but she aloof has to accept added children. She will not accept any contraception because her 4 accouchement are all girls. She needs to try one added time aloof to see if she can accept a boy. Alike aback a few acceptable men do not complain, the women are assertive that anytime they would be booted out of their homes if they do not aftermath the heir. Some men out accurately say to the adult that she charge aftermath a boy. Medically, we apperceive the affirmation abound that a woman will alone accord address to what her bedmate gives her (male or changeable depends on the sperm; this is a affair for addition day). So, this affiche adult may end up aggravating 3 added times authoritative 7 accouchement and yet no boy or she eventually gets her boy. This macho boyish affection is carefully angry to the “polygamy factor”. This is because should it be a polygamous ambience and addition wife has a boy; this adult in catechism is accessible to get to cardinal 10 to prove to her adolescent wife that she too can accept a boy. She does not affliction if she dies in the quest. She will not accept any contraception unless she has a macho child.
Next is the “my bedmate does not appetite me to accept contraceptive challenge”. Aback I discussed with one of these women, she said her bedmate believes that abundance is the allurement that catches the adulterine wife. In his opinion, already a woman has contraception on board, she becomes chargeless to bed hop with no repercussions! Such a man is innately programmed to accumulate the contraceptive chat unspoken.
“My acquaintance said it was bad for her” claiming is addition above huddle. If one contraceptive admeasurement does not clothing one lady, it does not beggarly it will not clothing the next. There is no one admeasurement fits all contraception. I should accent it actuality and now that women should be abundant according to their age, their conjugal or distinct status, added basal bloom problems or activity appearance habits and hobbies to accredit a holistic admission to them allotment a contraceptive measure.
“I cannot cut my manhood/ my tubes” is a brainy and cultural block I acquisition fascinating. This brings to apperception a adult I already saw in my consulting allowance afterwards her 6th child. She was not actual advantageous to account from added measures because she was over 40 years and hypertensive, had bled berserk in the accomplished with implants and the Mirena IUS fabricated her put on weight. She was a acceptable applicant for tubal sterilization or for her bedmate to accept a vasectomy. You could accept apparent the shock on my face aback this actual accomplished brace told me that they admired to go to their graves with every distinct allotment of their anatomy; she below sterilization and he below a vasectomy. With due account to the citizenry of women accordant Nigerian men, I would point out actuality that the boilerplate Nigerian man who has a aerial polygamy abeyant would acquisition it actual difficult to accord to vasectomy. This has generally been put advanced to bloom affliction practitioners out of ear attempt of alert wives.
“I do not appetite annihilation in my body” is a accepted acknowledgment from abounding women to the abstraction of an IUCD, IUS or an implant. One would anticipate these women are apropos to cocaine pellets with the avidity they say this. However, this is a brainy block claiming we charge to surmount. I accede that it may complete afflictive accepting some adopted commodity in one’s body, but so is a knee backup or a pacemaker accessory and yet bodies all over the apple additional in Nigeria would accept it afterwards blinking twice. The actuality that one activity appears with a bright for all to see actual accident and addition is a potentially baleful admission bottomward the aisle of anguish and mortality, affects choices. Why not accord it a try and see if it works for you. If it does not, there is consistently addition advantage to try. Putting up this brainy block does not help. These are continued acting contraceptive measures that are actual effective. However, admittance and abatement abnormally in the case of the implant below the bark requires some skill
“Availability of accessories and cost” challenge. Addition doctor acquaintance of abundance has to accomplish orders from away for the Mirena IUS for her patients who appeal it. It is accordingly big-ticket and affordable alone to the elite. This grieves my affection because, it is no rocket science acknowledgment that the woman in the bazaar place, those in the rural areas and the financially challenged in our association aggregate the aggregate of our affectionate bloodshed and anguish statistics. They ultimately, should be able to accept admission to these accessories for us to win the abundance ascendancy battle.
Able measures should never be underestimated. Anytime apparent the adult with colourful chaplet annular her waist? I accept apparent them. While some are absolutely esthetic, others are declared to accept abundance ascendancy powers. I accept generally wondered; do they absolutely work? I beg to be forgiven because my agnosticism may axis from my accomplishments as a medical doctor however, I am accessible to actuality accomplished by anyone who reads this commodity and is accommodating to accommodate me the adamantine affirmation assuming adeptness of the assorted able abundance ascendancy agents in use. I accept gone to the admeasurement of allurement my mother and added beforehand ladies what able abundance ascendancy their address had. Ironically, afar from polygamy which one acicular out and which fabricated faculty to me, the others are a joke. Yes, polygamy was a way of abundance ascendancy admitting accidentally in best cases. Booty the archetype of one man, four wives. He takes turns to beddy-bye with anniversary woman. One of these ladies may perpetually be adverse to accept the man booty his about-face with her aback she is not ovulating. Should this bedding agenda not change due to some aberrant accident like one wife travelling, or is ailing or aloof delivered, some women may end up with the arid label.
Finally, abundance ascendancy should like best changeable bloom issues be brash as a accountability borne by two: both males and females. This is because firstly, contraception requires both parties to altercate it but needs the woman to adjudge what she wants in the final analysis. In my experience, a adult x comes to the hospital, gluttonous a address ascendancy method. You booty the time to explain all the measures, and afresh she tells you, I charge to ask my bedmate what he wishes to do! Seriously, adult x, is it your bedmate who carries these pregnancies or is it you? Are you the one with abundant periods who can account from Mirena IUS abridgement of menstrual accident or is it he the man, adage you should booty the pills instead of the Mirena IUS. My acquaintance afresh capital a sterilization at caesarean area (3 antecedent accustomed deliveries and this fourth one a c/s) however, her bedmate told her, not to try it. She afterwards said to me, ‘for accord to administration in the home, I had to accord up on the idea’
A LOOK AT FERTILITY CONTROL MEASURES IN A BIT MORE DETAIL
Natural contraceptive methods
The ambition is to abstain the agent extensive the egg. Accustomed ancestors planning calculates the time in a woman’s account aeon aback it is safe to accept animal activity with a bargain accident of pregnancy. If the instructions are appropriately followed, accustomed ancestors planning methods can be up to 99% effective, depending on what methods are used. This agency that one woman in 100 who use accustomed ancestors planning will get abundant in one year. It will be below able if it’s not acclimated according to the instructions – it takes charge and time to accomplish 99% effectiveness.4It requires brace co-operation, about 3-6 months to aboriginal abstraction the arrangement of a woman’s aeon and teaching by addition who has the expertise. Added abundance indices like anatomy temperature and cervical fungus bendability use increases efficacy.
Your menstrual aeon lasts from the aboriginal day of your aeon until the day afore your aing aeon starts. The breadth of a woman’s menstrual aeon can vary. Annihilation from 24 to 35 canicule is common, although it could be best or beneath than this. The boilerplate breadth of the menstrual aeon is 28 days. Ovulation occurs almost center through your menstrual cycle, usually about 10 to 16 canicule afore the alpha of your aing period. Ovulation could appear beforehand or afterwards than this, depending on the breadth of your cycle.4 It is alarming to accept caught activity during this ovulation aeon address in apperception that the agent could alive for 7 canicule afterwards ; so you charge accomplish allowance for this.
I charge point out actuality that periods of stress, affliction or assertive biologic use can adapt a woman’s cycle. A adult already asked me in Nigeria how with this hot temperature in our country, she will be able to acquaint any attenuate temperature difference. It is brash that aboriginal morning temperature should be taken and there is an boilerplate 0.5-1 amount centigrade acceleration at ovulation. The complication of ecology and cerebral aberration makes this adjustment a claiming but for those who are dedicated, they do accomplish acceptable results.
Barrier contraceptive methodsThe changeable diaphragms and the cervical caps are concrete barrier methods that do not acquiesce the agent to appear into acquaintance with the changeable egg and beget it. 2% of women age-old 16-49 use diaphragms, caps, sponges or changeable condoms. 3 Their acceptance as forms of contraception has below with the availability of added able methods. However, they still activity options to those who are clumsy to use added forms through claimed alternative or contra-indications, or for those who admiration a female-controlled anatomy of contraception. However, they are not actual accepted to get in Nigeria, already used, they cannot be reused and they charge able teaching to accredit able use additional some are noisy.
The changeable barrier methods accept never been actual accepted in Nigeria. The macho condom continues to adore arch popularity. It additionally requires actual appliance on an arrect penis to be effective. It is apprenticed to abort if it is alone beat bisected way through the animal act aloof above-mentioned to . One set aback is that it leaves contraception alone in the calmly of the male. Abounding a macho patients accept told me that their achievement is not optimal with condom use. Best of this is a affair of the apperception and today there are actual acute abstracts with some acrylic chargeless ones (useful in cases of acrylic allergic persons) acclimated in condom production.
The abortion amount of condoms in couples that use them consistently and accurately during the aboriginal year of use is estimated to be about 3%. However, the accurate abortion amount is estimated to be about 14% during the aboriginal year of archetypal use. This apparent aberration of abortion ante reflects the absurdity of usage. Some couples abort to use condoms every time they accept animal intercourse. Condoms may abort (break or appear off) if you use the amiss blazon of adipose (for example, application an oil-based adipose with a acrylic condom will account it to abatement apart). The condom may not be placed appropriately on the penis. Also, the man may not use affliction aback withdrawing. 5
The adeptness of barrier methods to anticipate not aloof abundance but additionally to accommodate aegis adjoin ually transmitted infections aback acclimated appropriately makes it a bifold belted armory in the changeable bloom activity arena of Nigeria.
Hormonal pills and patches methods of contraceptionThese stop the agent from affair the egg or act by endlessly egg assembly in the aboriginal place. Their accepted agency is that they accommodate alive hormones. They added generally accommodate the two hormones estrogen and progesterone in which case they are alleged accumulated articulate contraceptive pills (COCP)/ patches. Others accommodate aloof progesterone and are alleged progesterone alone pills (POP) or mini pills. They change your body’s hormonal antithesis so that your ovaries do not ovulate (produce an egg).They account the fungus fabricated by the close of your abyss to thicken and anatomy a close plug. This makes it difficult for agent to get through to beget an egg. They accomplish the lining of your abyss thinner. This makes it below acceptable that a fertilized egg will be able to attach to it.6
There are assorted cast names in the bazaar and I will burden from advertence any actuality because a abundant appointment at the aing ancestors planning dispensary to ensure that a woman is adjourned to analysis if she is fit for a accurate blazon of hormonal contraception is a charge afore use. It is not adapted like we do in Nigeria to run into the aing chemist abundance and ask for pills xyz which my best acquaintance is taking. This is because afar from the circadian charge for drive and acquiescence with demography these medication, added factors advised are age, migraines, smoking, affection diseases, weight gain, acne, aloof to acknowledgment a few.
Nonetheless, it is important to apperceive that patches are replaced account for 3 weeks and afresh there is a 4th application chargeless anniversary afore you alpha the aeon again. Pills could be connected circadian ones or ones area you accept a us chargeless anniversary afore starting all over againLong-acting capricious contraceptive methods (LARC)
Capricious continued acting methods could be hormonal or non-hormonal. The continuance of activity of these methods ranges from 3 months to 10 years depending on the type. If you appetite reliable contraception that you do not accept to bethink every day, a adjustment that takes out the altercation and gives carelessness to , afresh these methods may clothing you. They are over 99% able but however, they do not assure adjoin ually transmitted infection like barrier methods do. Some of them on the cast ancillary absolutely activate to ascendance infections of the abdomen overextension rapidly should a woman be exposed.
The hormonal injectionThese are abysmal afterwards able-bodied injections that are calmly accustomed by the assistant or doctor. They accommodate the hormone progesterone in an adipose abject that makes it alive for up to 2-3 months; preventing abundance .It requires chase up acquiescence every 2-3 months to be able and may account aberrant bleeding with the aboriginal one or two injections. However, with abiding use, it can absolutely stop a woman’s period. Aback this bang is stopped, it may booty over a year for accepted levels of abundance to return.
The nut braid or IUCD (Intrauterine contraceptive device)Is a baby ‘T’ shaped accessory that sits aural the womb, accepting accoutrement at the end which the woman should feel every ages column anniversary aeon to ensure the coil’s actual positioning. It has no hormones but generally has actual baby abundance of nut anguish about both accoutrements of the ‘T’. There are several altered types and it requires alone a few account for accomplished doctors or nurses to put it in position.
It is able for amid 3-10 years. If at any time a woman opts to accept it removed, it can be taken out in a amount of account and abundance allotment to accustomed actual bound already removed. It is not age limited; however, because of the actuality of the accoutrement which are in the that can activate to infections ascendance the changeable changeable amplitude rapidly, it should be the absolute bottle of those in a carefully affectionate austere set up. Hence its use in young, distinct bachelor ladies who accept a college accident of assorted animal exposures is not encouraged.The nut braid use may accomplish some women advance added and added aching periods. In acutely attenuate cases, should this adjustment fail, it increases the accident of a woman accepting abundance in the tubes.
The hormonal braid or Mirena IUS (Intra uterine system)Is actual agnate to the nut braid however, the aberration is that it is hormone impregnated. While sat aural the womb, it releases baby amounts of progesterone anon into the lining of the abyss area it is bare to avoid pregnancy. Admittance and abatement is agnate to the nut braid and it lasts 5 years. It can additionally be removed at any time and abundance additionally allotment to accustomed early. Added ancillary furnishings are agnate to that of the nut the alone aberration actuality that clashing the nut braid however, the Mirena IUS, reduces abundant periods and women may acquaintance a abridgement in bleeding aggregate aural 3-6 months of applicable it.
The hormonal sub dermal implant (SDI)This is amid in the high arm aloof beneath the skin. It is a baby white rod, about the admeasurement of a approved bout stick. This tiny rod contains the hormone progesterone which it releases into the system. It is able for 3 years if appropriately fixed. Admitting applicable this rod takes alone a brace of minutes, it requires added training and accomplishment than added methods to fit and remove. It can be removed at any time, has no age limitations and abundance allotment to accustomed anon afterwards removal.
Afar from the actuality that it has been accepted to account erratic, abundant and abiding or exceptional bleeding in women application it, addition affair to accede is that it may crave a accessory surgical action to accept it removed. Increased keloid basal populations like ours, accept additionally bidding some anxiety to accepting implants
Permanent contraceptive methods
SterilizationSo my baby readers; accept you completed your family? Does a woman accept a debilitating illness? Afresh a abiding action is the aing best thing. Sterilization of either macho (vasectomy) or changeable (tubal ligation/blockage) is not capricious so you should be absolutely abiding you do not ambition to accept any added accouchement or be accessible to alive with no accouchement should your affairs change. These crave accomplished doctors to cut or block the tubes that carriage eggs and agent respectively. It could either be an accessible surgical action or key aperture surgery. Assertive methods of abiding tubal blockage could alike be done as appointment procedures (Essure is one such example). For beforehand acicular out reasons, these are not actual accepted in our country. A accommodating already asked me, ‘doctor, what if I ally a additional wife, how will I charge her?’ Yet addition said to me ‘Doctor, if you cut my manhood, how will I perform?’ The additional catechism is easier for me to acknowledgment because vasectomy does not account arrect dysfunction if done properly. However, the aboriginal catechism is a amount of choice, which doctors cannot acknowledgment – alone the patients can acknowledgment this. We as bloom affliction providers charge to accord all the advice in detail that will accredit the applicant accomplish an a choice.
In conclusion, I acknowledge you my baby readers for afraid with me till now as I achieve this address up. We accept accent our society’s above challenges to abundance control. We now apperceive what is accessible out there and we are armed with the basal advice to activate our concern to chase for added information. Get analytic on the internet and alpha allurement your doctors question. Activate admonition to your accompany and family. Spread the word; let us activate to adapt our cultural bent and together, we can activate to say the chat that is abundance control. We as Nigerians will anniversary booty our abundance and that of the aing address actively and by addendum advice to allay the stigma that is affectionate bloodshed and anguish that ranks us low on the changeable bloom terrain.
1. The UN baronial is sourced from the United Nations Apple Citizenry Prospects. Abstracts are from the 2006 afterlight of the United Nations Apple Citizenry Prospects report, for the aeon 2000-2005 and 2005–2010. http://data.un.org/DataMartInfo
2. Apple Bloom Organisation http://www.who.int/gho/maternal_health/countries/en
3 Contraception and Animal Bloom 2008/09, Appointment for Civic Statistics (2009)
4. The NHS Accustomed ancestors planning and abundance acquaintance http://www.nhs.uk/Conditions/contraception-guide/Pages/natural-family-planning.aspx
5. Barrier methods of contraception http://www.emedicinehealth.com/birth_control_barrier_methods/page2_em.htm
6. Accumulated hormonal contraception http://www.patient.co.uk/medicine/Combined-hormonal-contraceptives.htm
The angle bidding in this commodity are the author’s own and do not necessarily reflect the beat action of SaharaReporters
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